More healthcare IT advice for the president-elect

In part one of this story, we reported what healthcare leaders thought the administration of President-elect Barack Obama might do to promote healthcare information technology. We also asked leaders what they would say if given a chance to advise the president-elect with 15 minutes of face time.

Thomas Roovers is president of T.G. Roovers & Associates, a Wausau, Wis.-based IT consulting firm for office-based physician practices, where the penetration rate for electronic health records and the uptake of electronic prescribing, both of which have been promoted heavily by the Bush administration, remain low.

Roovers would advise Obama to first surround himself with experienced individuals, grounded in the reality of healthcare information technology.

I do not believe the current and Clinton administrations took the time to listen to grounded, experienced and insightful operational individuals who clearly understand the issues and challenges facing our healthcare industry, Roovers said. Once the expert panel was in place, Roovers said they should work to develop a package of new and attractive incentives and penalties to stimulate and encourage the use of existing and new information technology applications throughout the healthcare industry.

Roovers said the Obama administration should approach the health IT adoption problem in distinct segments, including inpatient facilities by size, privately owned physician practices, academic settings, emergency medicine, mental health and other specialties, with experts at the operation levels of these segments driving policy. In the past, I believe the previous administrations attempted to devour the entire elephant all at once, Roovers said. This will not work.

Jody Pettit is a physician and the strategic work-group leader developing a testing and certification program for personal health-record systems at the federally funded, not-for-profit Certification Commission for Healthcare Information Technology. She previously served as director of the Oregon Health Information Infrastructure project of the Oregon Health Care Quality Corp., and was named by Gov. Ted Kulongoski as Oregon's health IT coordinator.

Pettit would advise Obama to devote resources to the legal challenges created by PHRs.

We need laws that support the new PHR environment, Pettit said. The laws must help individuals access and use their personal health information through PHRs, while protecting privacy in ways that Americans expect.

Joel Shoolin is a family practitioner with the Advocate Health Care system, Oak Brook, Ill., and its vice president of clinical informatics and a member of the Association of Medical Directors of Information Systems.

Despite the nations financial woes, Shoolin said he thinks Obama will be forced to focus on healthcare as well as the financial system. Shoolin predicts the new administration will work with Congress to substantially add more grant money for demonstration projects and will sponsor and support incentive money to hospitals and physicians who use HIT, while diminishing the penalization for not using it, as Mr. Obama's attitude is one of positive rather than negative reinforcement.

Given 15 minutes of one-on-one with Obama, Shoolin would give the elevator pitch for health IT.

HIT is so important to provide safe patient care as it provides alerting and decision support to prevent errors, Shoolin said he would tell the president-elect. While not perfect, it beats what we had in the pastour memories. HIT can create value, as it will increase quality and ultimately decrease cost by avoiding costly mistakes and errors. The American people deserve better care. Leadership support from the highest levels of government will help force changethat bears out in any change scenario, so your support will make this happen.

Eric Liederman is a physician director of medical informatics at Kaiser Permanente, Oakland, Calif. Liederman said Obamas pledge to invest $50 billion on health IT was extremely intelligent, but Liederman is skeptical, based on past experience. Im not expecting to see pennies from heaven, myself, he said. With the government already committed to hundreds of billions in a banking bailout package and talk of another, consumer-focused economic stimulus, There wont be any money.

But the fact is, lets face it, what has the federal government actually delivered? The track record is pretty thin. CCHIT is a success. There has been some success on the terminology-standardization front.

If Liederman had time alone with Obama, he said hed advise the president-elect to concentrate government efforts in that very areastandardization, particularly around pharmaceutical identification.

There is a lot of good work around National Council for Prescription Drug Programs codes, he said. They are useful from a supply-chain perspective, but they are not sufficiently information-rich from an electronic medical-records standpoint. Theyre good for what theyre good for, moving product and payment. But we dont give individual patients 100-count bottles in the hospital.

I think another good thing would be standardization around barcoding and RFID (radio frequency identification). What Id love to have is unit dose medications with a standard bar code or RFID so we can choose. We dont have that. It would improve the safety of pharmaceutical administration. You want to make sure you do the five rights every time and how do you do that with insufficient information? And if you can track what happened and when, you can do the kind of pharmaceutical research thats very challenging to do now. You dont know the real doses and time, so you cant derive the real pharmacological impacts.

If they could come up with standards, then we could apply the standards with our own money, Liederman said.

Ned Moore is the chief executive officer of Portico Systems, Blue Bell, Pa., developer of a suite of software tools health plans use to manage provider relationships, including recruiting, credentialing, contracting and pricing.

Payers, Moore said, are going to have their work cut out for them if Obama succeeds in bringing the 47 million uninsured into some form of an insurance-based healthcare coverage system.

On the provider side of EHR systems, adoption remains low while a majority of primary-care practices are small and financially challenged, twin realities that may not be going away anytime fast, Moore said.

Its going to be an evolution, Moore said, with incremental progress in IT adoption and use. For example, he said, payers still may not be willing to subsidize the cost of physicians full-featured EHRs, but they are showing a willingness to fund technologies short of an EHR that will help make a medical home work. While there should be a long-term lT adoption strategy, there should be one for the short-run, too, that will allow for incremental improvements.

This system has to provide for the fact that there is going to be ongoing paper processes, but that doesnt mean we cant have tools to help manage medical homes, even short of them having an entire EHR.

For example, Moore said, with existing technology, payers can use their claims data and communicate to physicians who dont have an EHR which of their patients havent filled their prescriptions, information a physician can use to provide better medication management for patients with chronic illness.

What Id advise (Obama) to do is support information connectivity, Moore said. What were seeing is, with the medical home, the connectivity part between a provider and a member is going to determine if we drive the cost savings.

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